Comparison of Postoperative Analgesic Effects of Intravenous versus Perineural Dexamethasone Injection Combined with Ropivacaine in Thoracoscopy-Guided Thoracic Paravertebral Block for Thoracoscopic Radical Lung Cancer Resection: A Prospective Randomized Controlled Trial.

Background: As an adjuvant, dexamethasone can enhance the analgesic intensity and prolong the duration of nerve blocks. However, to date, no studies have compared the effectiveness of different administration routes of dexamethasone for thoracoscopy-guided thoracic paravertebral block (TTPB). This prospective randomized controlled study evaluated the postoperative analgesic effects of dexamethasone administered intravenously or perineurally in combination with ropivacaine for TTPB in patients undergoing radical lung cancer resection.

Methods: A total of 150 patients were randomly assigned to receive dexamethasone intravenously (Group I, n=75) or perineurally (Group D, n=75). Before wound closure, patients in Group I underwent TTPB with ropivacaine while receiving an intravenous dexamethasone injection, whereas patients in Group D received a perineural mixture of ropivacaine and dexamethasone. The primary outcome was the time to first postoperative rescue analgesia. Secondary outcomes included Visual Analogue Scale (VAS) scores, postoperative 48-hour sufentanil consumption in patient-controlled intravenous analgesia (PCIA), postoperative blood glucose levels, postoperative recovery parameters, and incidence of adverse events.

Results: Compared with Group I, Group D showed a significantly longer time to first postoperative rescue analgesia, lower VAS scores at all assessed time points, and reduced postoperative 48-hour sufentanil consumption. Group D also showed a smaller increase in postoperative blood glucose levels, an earlier time to first ambulation and a shorter postoperative hospital stay (all P < 0.05). However, the incidence of postoperative nausea was higher in Group D than in Group I (P < 0.05).

Conclusion: In TTPB, perineural dexamethasone administration with ropivacaine provided superior and longer-lasting analgesia compared with intravenous administration. Additionally, it accelerated postoperative recovery and shortened hospital stay.